WSC 2026 | 2026 update on the left atrial appendage and its closure for stroke prevention

Yeah, this is the closure after stroke. We have to distinguish between ischemic stroke and hemorrhagic stroke because now during the WSC, the ENRICH data were presented showing that reintroduction of edoxaban after intracerebral hemorrhage reduced the occurrence, the risk of ischemic stroke with a threefold higher risk of bleeding. So for many years, we said we were quite confident in controlling the risk factors after intracerebral hemorrhage that the risk-benefit was discussable case by case. But now in this largest stroke trial, intracerebral hemorrhage trial that we have, we see that there is a greater risk. So probably there will be a patient meta-analysis putting together all the trials, but it’s a strong direction that there is an increase of risk in intracerebral hemorrhage. So in these cases, we have to consider also left atrial appendage occlusion, especially now where the devices are much safer, because they do not need long terms of anticoagulation. We have now NOACs for a short term. Maybe we can go also only for one aspirin, not always stopped. So we have more options in order to close the left appendage without the association of medical treatment. And the second novelty is about ischemic stroke, especially in those who are on DOACs, well-controlled patient with atrial fibrillation. They then have a breakthrough stroke. And in these cases, on top of DOAC treatment, we should consider also a left atrial appendage occlusion. We have two trials which are going on, LAAOS-4 and ELAPSE trial. We will see, but in the meantime, it’s clear that probably those who are not involved in these big trials should consider that to close the left atrial appendage on top of anticoagulation.

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